Optimizing surgical instrument sets for cases involving breast and plastic surgeons.

Abstract

33 Background: Processing operative instrumemt sets is a major cost for surgical cancer care. Optimizing standard sets requires availability of instruments reflecting varied surgeon preferences while minimizing unnecessary instruments. Additionally, increasing utilization of oncoplastic reconstruction after mastectomy and lumpectomy requiring breast and plastic surgery sets further expands the number of instruments required. The goal of our study was to optimize standard sets used for cases combining breast and plastic surgeons and to determine cost savings Methods: Baseline data was recorded over a 2 week period (13 cases) including number of instruments available and number unused for non- flap breast-plastics combo (BPC) cases. An independent observer timed instrument set-up times. 22 breast and 14 plastic surgeons were polled for their requested instruments for designated cases. A BPC set was designed based on this data and reviewed with surgeons to update preference cards. After a 6 week implamentation/education period, repeat data was recorded (18 cases). Cost of instrument processing was based on labor and supply cost of $0.22/instrument. Results: Two breast surgery sets (65 and 97 instruments) and one plastics set ( 93 instruments) were used at baseline. The median number of available instrumeets was 172.5/case, with median 126.5 instruments unused. A mean of 3.8 separately packaged instruments were required per case with mean set-up time of 4m46s. The new BPC set contains 103 instruments. A median of 106.5 instruments were available after implementation. The median number of unused was reduced by 53% to 59.5, with a drop in number of separately processed instruments to 2.5. Mean set-up time was reduced to 2m16s. Reducing the size of of standard sets reduced processing costs by $12.10 or $19.14/case (depending on the breast set used for comparison). Combining sets resulted in an additional cost savings of $6.56/case by reducing extra packaging costs. Conclusions: combining breast and plastic sets and eliminating unnecessary instruments resulted in cost savings of $18.66-$25.70/case. It also reduced OR instrument set-up time by 2.5 minutes/case which has significant impact at high volume centers.